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Saturday, 19 October 2013

The role of traditional medicine practice in primary health care within Aboriginal Australia

The practice of traditional Aboriginal medicine within Australia is at risk of being lost due to the impact of colonisation. Displacement of people from traditional lands as well as changes in family structures affecting passing on of cultural knowledge are two major examples of this impact. Prior to colonisation traditional forms of healing, such as the use of traditional healers, healing songs and bush medicines were the only source of primary health care. It is unclear to what extent traditional medical practice remains in Australia in 2013 within the primary health care setting, and how this practice sits alongside the current biomedical health care model. An extensive literature search was performed from a wide range of literature sources in attempt to identify and examine both qualitatively and quantitatively traditional medicine practices within Aboriginal Australia today. Whilst there is a lack of academic literature and research on this subject the literature found suggests that traditional medicine practice in Aboriginal Australia still remains and the extent to which it is practiced varies widely amongst communities across Australia. This variation was found to depend on association with culture and beliefs about disease causation, type of illness presenting, success of biomedical treatment, and accessibility to traditional healers and bush medicines. Traditional medicine practices were found to be used sequentially, compartmentally and concurrently with biomedical healthcare. Understanding more clearly the role of traditional medicine practice, as well as looking to improve and support integrative and governance models for traditional medicine practice, could have a positive impact on primary health care outcomes for Aboriginal Australia. 

Traditional medicine practice (TMP) within Aboriginal Australia encompasses a holistic worldview which reflects that of the World Health Organizations definition of health, which is one of ‘physical, mental and social wellbeing and not merely the absence of disease or infirmity’ [1]. This worldview recognises good health as a complex system involving interconnectedness with the land, recognition of spirit and ancestry, and social, mental, physical and emotional wellbeing both of the individual and the community [2]. Indigenous Australians view ill health as the result of one of three causes – a natural physical cause, a spirit causing harm, or sickness due to sorcery [3]. The impact of colonisation and the subsequent displacement and disconnection of people both from their traditional lands and later from their traditional families has been significant in its subsequent effect in the use of traditional practices including traditional medicine [4].
The Alma-Ata declaration on primary health care (PHC) by the World Health Organization (WHO) in 1978 witnessed a response from several countries to improve their traditional medicine use and regulation of use within the primary health care model. PHC for Aboriginal and Torres Strait Islander Australians is currently addressed by either government controlled health services or community controlled health services (ACCHS) that offer biomedical health care and employment to trained Aboriginal Health Workers (AHWs). ACCHS are initiated and governed by the local Aboriginal Community to enable delivery of holistic and culturally appropriate healthcare to the respective community/ies [5]. This holistic approach in the evolvement from primary medical care to primary health care as adopted by the Alma-Ata declaration in 1978 has been praised, however there has been no mention of the incorporation of traditional medicine use within the design of these health services as other countries have [6]. It is acknowledged that in remote areas in other countries it is common for traditional medicine to coexist with biomedical healthcare as part of a pluralistic medical system [7]. It is unclear if this also applies to Aboriginal Australia and if so, to what extent traditional medicine is practiced and how it sits with the use of biomedical healthcare.
The purpose of this review is to identify available literature that examines or discusses the role (as in position/function) of TMP in a PHC setting within Aboriginal Australia. Treatment modalities within TMP for the review will be inclusive of Traditional Healers (TH), herbal medicines, ceremonies and healing songs [8]. Whilst it is recognised that bush foods also play a role in traditional health practices, specific articles on bush tucker and nutrition will not be included due to the limitations on the length of this review. TMP will be examined overall for the extent/level of use, when they are used (i.e. first or second line), how they are used (i.e. alone or in combination with biomedicine), what they are used for (i.e. types of illnesses) and the reasons behind the when, how and what.


http://www.ethnobiomed.com/content/9/1/46

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